Concussions, sometimes referred to as mild traumatic brain injuries, are a significant public health issue in this country. Prevalence estimates vary widely, ranging from 300,000 sports related concussions annually (a CDC earlier estimate) to over 2 million sports and recreation related concussions annually (revised current CDC estimate). Medically, there is great variety in procedures for evaluating concussion. Despite this, research has consistently documented the presence of cognitive impairment resulting from concussion. Findings have reliably shown that cognitive processes, including attention, information processing speed and working memory can all be impaired. It is remarkable that these same cognitive domains have been identified as relevant to driving capacity in other clinical populations, yet the impact of cognitive impairment on driving following a concussion has not been examined. The overarching objective of this proposal is to initiate a systematic approach to examining this relationship. The use of virtual reality (VR) driving simulation is a promising, novel approach for evaluating driving capacity among persons with neurological compromise. VR simulation allows the presentation of interactive, "real world" driving scenarios that can be used to objectively assess driving capacity, in a safe but challenging manner. The current study will employ the use a VR driving simulator to examine driving related skills in individuals who have sustained concussions. Specifically, 50 individuals with medically diagnosed concussion will be administered a cognitive, visual and VR driving evaluation within 48 hours of an individual sustaining a concussion. In addition, a second VR driving evaluation will be conducted 48 hours after the individual has been medically cleared to return to everyday activities. The specific aims are: 1) define the relationship between cognitive impairment resulting from concussion and driving skills as measured by a VR driving simulator, 2) to compare both cognitive and functional (i.e., driving) performance at the initiation of a concussion (within 48 hours) and at post- concussion (48 hours after medical clearance). Finally, an exploratory aim is to identify potential clinical risk stratification findings by evaluating performance of individuals with varying levels of concussion severity (defined clinically). PUBLIC HEALTH RELEVANCE: The presence of cognitive impairment following concussion is well documented, but its impact on driving capacity has not been examined. Understanding this could help clinicians make clear clinical recommendations and potentially minimize risk of impaired driving in this population.